Second-look surgery in patients with peritoneal dissemination from appendiceal malignancy: Analysis of prognostic factors in 98 patients

Objective To establish selection criteria for reoperation in patients with peritoneal dissemination from appendiceal malignancy. Summary Background Data The outcome of patients with mucinous appendiceal neoplasms with peritoneal surface dissemination has changed as a result of a better understanding of the clinical and pathologic features of this disease. This knowledge, comb ined with aggressive strategies for the use of perioperative intraperitonea l chemotherapy and peritonectomy procedures, has resulted in long-term dise ase-free survival in many of these patients. However, some of the patients develop progressive disease, and a question regarding additional surgery is appropriate. A critical analysis of the results of second-look surgery sho uld assist in the management of patients with recurrent peritoneal surface dissemination of an appendiceal neoplasm. Methods Three hundred twenty-one patients with epithelial peritoneal surface malign ancy of appendiceal origin underwent surgery during a 12-year period. Ninet y-eight of these patients (30.5%) underwent a second-look procedure. A data base of selected clinical features regarding these 98 patients was gathered from the clinical records. A critical statistical analysis of these clinic al features and their prognostic impact was performed using survival as an endpoint. All patients were managed by a treatment regimen that used cytore ductive surgery and intraperitoneal chemotherapy. Results The overall 5-year survival rate of these 98 patients was 73.6%. This compa red favorably with a 68% survival rate of 223 patients who did not undergo reoperation. Survival based on the number of cytoreductive surgeries and th e free Interval between them showed no significant difference. Patients who had second-look surgery with bowel obstruction as a symptom and those in w hom the amount of tumor was increased or minimally decreased at the first a nd second cytoreductions had a significantly inferior 5-year survival rate. A complete second cytoreduction was associated with an improved 5-year sur vival rate. Conclusions Follow-up of patients treated for peritoneal dissemination from neoplasms o f appendiceal origin is indicated. Selected patents in whom recurrence deve lops are candidates for repeat cytoreductive surgery plus intraperitoneal c hemotherapy with curative intent.